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How To Treat Knee Meniscus Tear With Arthritis

What Causes A Meniscus To Tear

Knee Osteoarthritis and Degenerative Meniscus Tears – Brian Feeley, MD

A forceful twist or sudden stop can cause the end of the femur to grind into the top of the tibia, pinching and potentially tearing the cartilage of the meniscus. This knee injury can also occur with deep squatting or kneeling, especially when lifting a heavyweight. Meniscus tear injuries often occur during athletic activities, especially in contact sports like football and hockey. Motions that require pivoting and sudden stops, in sports like tennis, basketball, and golf, can also cause meniscus damage. The sports injury does not have to occur during a game but can also occur in practice, where the same motions lead to meniscus damage.

The risk of developing a torn meniscus increases with age because cartilage begins to gradually wear out, losing its blood supply and its resilience. Increasing body weight also puts more stress on the meniscus. Routine daily activities like walking and climbing stairs increase the potential for wear, degeneration, and tearing. It is estimated that six out of 10 patients older than 65 years have a degenerative meniscus tear. Many of these tears may never cause problems.

Because some of the fibers of the cartilage are interconnected with those of the ligaments that surround the knee, meniscus injuries may be associated with tears of the collateral and cruciate ligaments, depending upon the mechanism of injury.

What Is The Meniscus

Three bones come together to form your knee joint: the femur , tibia , and patella . Between the femoral and tibial components of the knee, there are two wedge-shaped pieces of cartilageeach one is called a meniscus. Each tough and rubbery meniscus serves to cushion the knee joint and stabilize it.

Is An Injection Effective For A Meniscal Tear

Most meniscal tears improve with a period of rest and a course of physiotherapy. Surgery is indicated only if you have certain mechanical symptoms. These symptoms may include locking of the knee and a significant reduction in the range of movement. Pain is not an indication for surgery unless accompanied by these mechanical symptoms.

Injection therapy is indicated for a specific group of patients where surgery is not appropriate and pain is limiting the range of movement and function. An injection does not heal the tear but does reduce the pain and inflammation in the joint. An injection can give you a pain-free window to work with your physiotherapist to strengthen the knee and restore the normal mechanics of the joint.

Often the pain associated with a meniscal tear is not coming from the tear itself but inflammation of the joint lining. The lining of the joint is called the synovium. When the synovium becomes inflamed it is called joint synovitis. Diagnostic ultrasound is the best way of diagnosing synovitis.

At Complete, we will always perform a diagnostic ultrasound of your knee before we consider injection therapy. This also helps us target the correct area of the knee with an injection. We do not charge extra for the ultrasound prior to injection.

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Can A Torn Meniscus Heal On Its Own

The injury to the knee, on the other hand, may heal on its own. The truth is that there are several different types of tears in the knee, some of which will not heal unless care is taken. If your tear is located on the outer one-third of the meniscus, it may heal on its own or be repaired surgically.

Meniscal tears can occur in a variety of ways, including trauma and degeneration. When a knee is bent slightly, the most common cause of the injury is a twist. There is a chance that your tear will heal on its own or that surgery will be required. When a torn knee joint is swollen and tender in the outer and inner joint lines, or when the active range of movement of the knee is limited or painful, it is usually caused by a torn knee joint. Surgery is usually the best option for patients with an inner two-thirds tear. The first sign that you have rotation pain is that it reproduces, and you should consult a physiotherapist. Extra-articular conditions associated with lateral meniscal tears include iliotibial band syndrome, proximal tibiofibular joint instability, biceps snapping femoris or popliteus tendons, and peroneal nerve compression syndrome or neuritis.

Meniscus Tear Recovery Time Without Surgery

When a Repair May Be Better Than Removal of Your Torn Meniscus ...

The recovery time for a meniscus tear without surgery can vary depending on the severity of the injury. A small tear may only require a few weeks of rest and physical therapy, while a more severe tear may require up to six months of recovery. Surgery is often not necessary for meniscus tears, and the majority of patients are able to recover fully without any long-term complications.

Arthritis can be caused by a variety of factors, including cartilage, ligaments, and the knee joint. Meniscus is a type of figure-eight fibrocartilage that protects the bones between your thighs and shins. Tears in the white zone are more difficult to heal because they lack blood supply, which usually makes them difficult to heal. Physical therapy is the most effective method of treating knee pain caused by a tear in the cartilage. After surgical removal, there is an increased risk of early arthritis and a subsequent knee replacement. PRP and bone marrow stem cells are precisely injected into the damaged or torn knee at Centeno Schultzâs clinic. Paavola M, Malmivaara A, Joukainen A, Nurmi H, Kalske J, and Jrvinen TL contributed.

The FIDEITY study is a Finnish group studying the condition ofgenerative meniscal joints. It is performed in conjunction with a partial meniscectomy to treat a degeneration of the meniscal tear. Med J Med 2013 N Engl J Med. The Journal of Applied Linguistics, 29 December 2011 369 :2515-24.

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What Percentage Of Meniscus Tears Require Surgery

Less than 10 percent of meniscal tears occurring in patients age 40 or older can be repaired. This is often because the tissue degeneration affects blood flow to the cartilage, making healing less likely after surgery. A doctor may recommend removing the damaged tissue and suggest physical therapy exercises.

Does A Meniscus Tear Need Surgery

The only meniscal tears that need surgery are those that can be repaired, or tears that give persistent pain despite good quality non-operative care. In general, if you are over 30 years old the meniscus has reduced healing potential and is less likely to be repaired as the blood supply to your meniscus starts to diminish.

If you have a tear of the meniscus in or near the blood supply, the meniscus may heal if surgical stitches hold it together whilst it heals . The stitches themselves are not very strong so if the meniscus injury is in an area without blood supply , the stitches will not repair the meniscus by themselves.

A specific type of meniscal tear called a bucket handle tear can occur and cause your knee to be locked . In all cases of a locked knee further medical assessment is required urgently as there are several causes of a locked knee. If you have a bucket handle meniscal tear you will need urgent surgical referral for either repair or partial meniscectomy. Non-operative treatment is not an option for bucket handle meniscal tears.

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How Is A Torn Meniscus Diagnosed

Your doctor will ask about your symptoms and the circumstances of your injury, and conduct a physical examination. Radiological imaging studies will be ordered to confirm a diagnosis: X-rays will help rule out fractures or other bone injuries as the cause of pain, and high-resolution magnetic resonance imaging studies will help reveal the type and location of the tear.

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Summary Of Meniscal Issues

Watch a Knee Surgeon Treat a Meniscal Tear
  • Meniscal tears are common in middle-aged people and may not be the cause of knee pain
  • Symptomatic meniscal tears should be treated with non-operative treatments for a few months before considering any surgical intervention
  • Surgery is a good option for pain that persists despite good quality non-operative treatment
  • Although surgery may help pain it will affect knee function and speed up osteoarthritis
  • The only tears that can be repaired are those in the outer edge of the meniscus, usually in people less than 30 years old
  • If you have a locked knee you need to see a doctor for urgent assessment

The Sports Medicine Physicians and Sports Physiotherapists at Newcastle Sports Medicine are experts in assessing and treating all knee issues including meniscal injuries. If you would like your knee assessed or treated please call 4910 0805 to make an appointment.

to Professor Jarvinen discuss his research on meniscal injury

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Can You Have A Torn Meniscus With Arthritis

The symptoms and causes of a tear are frequently found while playing sports. As people age or become arthritis-bound, they can cause cartilage damage by stepping on an uneven surface or stepping on a loose surface. Even if there is no knee injury, arthritis can cause tears in the hip and knee.

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If you experience any of the above symptoms, you should consult a doctor to determine your diagnosis and treatment options. There is no single answer to this problem however, when combined, a variety of treatments can often be effective.

How Long Can You Walk On A Torn Meniscus

In most cases, patients can walk without a knee brace and crutches for about two to three months. When recovering from a partial meniscectomy , it is less time consuming than when recovering from a torn kneecap.

The Different Types Of Knee Surgery And Their Recovery Times

The knee is a joint that allows a person to move freely. Walking and running can be dangerous if you donât have proper knees. If you have a knee injury, you may require surgery to repair the problem. Meniscectomy and MRI meniscectomy are the two most common types of knee surgery. The removal of the kneeâs cartilage disk, also known as the meniscus, is known as anterior knee osteotomy. The entire knee joint is being removed as part of a meniscectomy. It is critical to note that recovering from either surgery takes different amounts of time. Depending on the type of surgery and the extent of the injury, you may need to wait several days to recover. Following surgery, it is generally possible to resume normal activities within 4-6 weeks. Please do not hesitate to contact your doctor or surgeon if you have any questions about your recovery.

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How Does A Meniscus Get Injured

The meniscus is usually injured when someone has a bent knee and changes direction. Often the movement that injures the meniscus is no different to any number of movements you would make throughout a day such as rising out of a chair and pivoting.

It is rarer to have meniscal injuries when you are less than 30 years old as the meniscus is healthy and strong. As we age, meniscal tears become increasingly common as the meniscus wears down and erodes with time. For this reason, older people often dont notice a specific moment when they injure their meniscus as it usually just slowly fails and becomes frayed. Conversely, younger people do often report a specific incident where they hurt their knee as the force required to tear a young strong meniscus is much higher. In the older knee, meniscal tears are now being considered as part of osteoarthritis instead of a separate injury needing specific treatment.

KEY FACTS:

SEEING A MENISCAL TEAR ON MRI DOES NOT CONFIRM THE MENISCUS AS THE SOURCE OF PAIN

Treatments For A Meniscal Tear Without Surgery

Meniscus Tear
  • If you go to most pain practices if you fail physical therapy and surgery is not recommended, they may recommend a steroid injection, which can help temporarily reduce inflammation in and around the knee and meniscus, but this is not advised as steroids as we know can cause damage to the joint cartilage, inhibit healing, and has a host of other negative side effects.
  • An injection of something called hyaluronic acid, which is a naturally occuring substance that makes up part of the lubricating fluid of the knee joint, could be used for temporary pain relief. It does not help repair the area but may provide a few months of symptomatic benefit if there is not severe arthritis in the knee.
  • If you actually want to try and get the body to heal that meniscus on its own when rest and physical therapy has not do the job, PRP has excellent evidence that it helps with meniscal injuries as well as mild to moderate arthritis that can be associated with these issues. PRP, when used in the right hands, should be injected precisely with ultrasound guidance into the torn parts of the meniscus, into any ligaments or tendons that may be injured or loose, and into the knee joint itself for optimal results. Many practitioners just inject into the knee, which still can help quite a bit but not as much as if a more thorough approach is taken. There are more than 25 high level studies showing PRP helps with knee pain ).
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    Last Resort For Degenerative Meniscus Tears: Surgery

    Degenerative meniscus tears, part of the aging process, are the most common reason for knee arthroscopy because many primary care physicians and orthopedic surgeons believe that meniscus tears always require surgery. This is not the case, says Rodney Benner, MD, an orthopedic surgeon at Shelbourne Knee Center. Many degenerative meniscus tears will get better without surgery. Because we deal with knee problems all the time, were uniquely positioned to tease out factors that make it more or less likely that surgery will be effective.

    What Is A Meniscus Tear

    A meniscus tear is an injury that occurs to the meniscus, or cartilage, of your knee. This cartilage rests between your femur and tibia to make movement smooth and easy in this major joint.

    As one of the most frequently used, and injured, joints in the body, getting a meniscus tear is possible in people of all ages and throughout different levels of activity. While an older individual may experience a meniscus tear after a fall, a younger person could tear their meniscus during a game of soccer.

    Tears can vary in degree, which dictates how much pain and discomfort you may feel as well as whether or not surgery is a necessity right away. Because the cartilage throughout our entire body isnt given a good supply of blood, injuries to cartilage are slow, difficult, or impossible to heal naturally. Still, some patients with chronic tears that arent too large may experience relief with physical therapy and injections of anti-inflammatory medications for years before surgery becomes a necessity.

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    Do Meniscal Tears Predispose Patients To Develop Osteoarthritis

    Several studies have concluded that a meniscal tear can lead to knee osteoarthritis. On the flip side of that, knee osteoarthritis can lead to a spontaneous meniscal tear through breakdown and weakening of the meniscus. A degenerative meniscal lesion observed on MRI is suggestive of early osteoarthritis. Even with surgical resection to remove degenerative lesions, osteoarthritis may still progress.

    Partial meniscal resection has been associated with less radiographic knee osteoarthritis than total meniscectomy. There is also evidence that meniscal damage not treated surgically remains a significant risk factor for the development of radiographic knee osteoarthritis.

  • American Academy of Orthopaedic Surgeons. Meniscus Tears.

  • Is Knee Surgery Necessary To Repair A Torn Meniscus

    How to Know If Your Knee Pain is from a Meniscus Tear or Arthritis

    More serious meniscus tears may not heal on their own. If your injury doesnt improve with RICE, NSAIDs and physical therapy, your healthcare provider may recommend arthroscopic surgery.

    Surgery is a very effective way to repair a torn meniscus. If the tear is too big to repair, your surgeon may remove all or part of the meniscus. After recovery, your knee will be more stable, and youll be less likely to develop additional knee problems.

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    Will Walking On A Torn Meniscus Make It Worse

    A torn kneecap is unlikely to keep people from walking. Twisters and squats are more likely to cause pain and discomfort than walking. However, if you begin to experience pain while walking with a torn meniscus, rest your knee rather than continue.

    This is a common knee injury that occurs primarily during sports. It occurs when your knee is bent, resulting in a popping sensation. The swelling and stiffness of your knee will last 2â3 days after the tear. It is possible to help your injury heal by adhering to the treatment guidelines established by your doctor. Treatments are available in both surgical and non-surgical settings. Rest, icing, and taking anti-inflammatory medications are some of the nonsurgical treatments for torn cartilage. A surgical procedure can include injections or surgery.

    You can benefit greatly from physical therapy if you have difficulty moving or functioning in your knee. Depending on the type of surgery, it may take some time for the patient to recover from knee surgery. A surgical repair may allow you to recover in between 4 and 6 weeks. crutches and not bearing weight are examples of recovery methods. When you do not receive treatment, the pain can become worse over time. A doctor may be able to diagnose and advise you on the best treatment options for torn maniscuses. If you turn your knee too quickly, you may suffer from a traumatic knee tear.

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